24
Male Infertility
Craig Stuart Niederberger
Questions
1.For couples practicing optimal timing methods to conceive, the proportion who conceive after six cycles should be approximately:
a.1/2.
b.1/3.
c.1/5.
d.2/5.
e.4/5.
2.For couples desiring to conceive, around the time of ovulation, they should have intercourse:
a.daily.
b.twice daily.
c.every other day.
d.in the morning.
e.near noon.
3.In the industrialized world, female fecundity typically declines most rapidly after:
a.puberty.
b.age 30 years.
c.age 35 years.
d.age 40 years.
e.menopause.
4.All of the following medications are associated with male reproductive dysfunction EXCEPT:
a.cimetidine.
b.spironolactone.
c.indinavir.
d.prednisone.
e.lisinopril.
5.A man with oligoasthenospermia has inflammatory bowel disease and is prescribed sulfasalazine. He should be counseled to:
a.repeat a semen analysis.
b.continue sulfasalazine.
c.substitute sulfasalazine with colchicine.
d.substitute sulfasalazine with mesalazine.
e.discontinue all medications.
6.A 30-year-old man is attempting to conceive with his 28-year-old wife. She is diagnosed with premature ovarian failure, and hematoxylin and eosin microscopic staining of his sperm is consistent with the presence of Escherichia coli. His bulk seminal parameters are otherwise unremarkable. You recommend:
a.swim up and intrauterine insemination.
b.a 3-week course of ciprofloxacin, 500 mg twice daily.
c.prostatic culture.
d.seminal vesicle aspiration for culture.
e.observation.
7.The effect of human immunodeficiency virus (HIV) infection on bulk seminal parameters is:
a.none.
b.decreased motility.
c.increased number of morphologically abnormal forms.
d.decreased concentration.
e.decreased volume.
8.Direct exposure of the testis to ionizing radiation causes irreparable damage to spermatogenesis at doses at and above:
a.2.5 Gy.
b.5 Gy.
c.7.5 Gy.
d.10 Gy.
e.20 Gy.
9.The typical differential between core body and scrotal temperature is:
a.0.5° C.
b.0.5° F.
c.1° to 2° C.
d.2° to 4° C.
e.6° C.
.An 18-year-old man has bilateral testes palpable at the external inguinal rings. He desires to father children in the future. Two centrifuged semen analyses reveal azoospermia. Serum testosterone is 410 ng/dL, and follicle-stimulating hormone is 22 IU/L. The best next step is:
a.counsel that when he is ready, he and his partner should use donor sperm or adopt.
b.clomiphene citrate, 50 mg every other day.
c.testis biopsy.
d.microsurgical testis sperm extraction with cryopreservation if sperm are found.
e.bilateral orchidopexy.
.The lubricant that does NOT affect sperm function or DNA integrity is:
a.Astroglide.
b.K-Y Jelly.
c.PreSeed.
d.Replens.
e.saliva.
. The serum hormonal pattern commonly observed in male obesity is:
.The finding most consistent with spermatogenic impairment is:
a.a testis volume as measured by Prader orchidometer less than 30 mL.
b.a testis volume as measured by scrotal ultrasonography less than
30mL.
c.a testis longitudinal axis as measured by caliper orchidometer less than 4.6 cm.
d.an engorged epididymis.
e.an absent vas deferens.
.A man evaluated for azoospermia has absent vasa bilaterally. The next step is cystic fibrosis transmembrane conductance regulator (CFTR) gene sequence assay for him and his partner and:
a.transrectal ultrasound.
b.renal ultrasound.
c.postejaculatory urinalysis.
d.seminal vesicle aspiration.
e.testis biopsy.
.The following condition increases sex hormone–binding globulin (SHBG):
a.aging.
b.diabetes mellitus.
c.hypothyroidism.
d.obesity.
e.testosterone therapy.
.A man is found to be azoospermic. The following most strongly suggests spermatogenic dysfunction as a cause rather than obstruction:
a.testis long axis on physical examination 4.2 cm, FSH assay 4 IU/L.
b.testis long axis on physical examination 4.3 cm, FSH assay 10 IU/L.
c.bioavailable testosterone, 166 ng/dL, FSH assay 6 IU/L.
d.luteinizing hormone (LH), 2 IU/L, FSH 2 IU/L.
e.testosterone, 160 ng/dL, LH 9 IU/L.
.A reasonable threshold for sperm concentration above which a man can be considered fertile is:
a.15 million/mL.
b.20 million/mL.
c.48 million/mL.
d.80 million/mL.
e.200 million/mL.
. Brown-hued semen is often associated with:
a.ingested asparagus.
b.ejaculatory ductal obstruction.
c.sexual activity.
d.spinal cord injury.
e.urinary tract infection.
.The optimal time in days of abstinence to wait after an ejaculate for a semen analysis is:
a.1.
b.2.
c.3.
d.5.
e.7.
.A man who has been unsuccessful in impregnating his wife during the past year is identified to have azoospermia and semen volumes of 0.8 and 0.5 mL. The next step is:
a.testis biopsy.
b.scrotal ultrasound.
c.postejaculatory urinalysis.
d.clomiphene citrate, 50 mg every other day.
e.transurethral resection of ejaculatory ducts.
.A 32-year-old man presents for fertility evaluation. Physical exam and endocrine assessment are normal. Semen analysis demonstrates volume
2.5mL, density 84 million/mL, motility 71%, and strict morphology 0% with a variety of abnormal forms. The next step is:
a.vitamin E.
b.reassurance.
c.testis biopsy.
d.scrotal ultrasound.
e.antisperm antibody assay.
.Two semen analyses from a man undergoing a reproductive evaluation include volumes of 2.5 and 1.8 mL, densities of 24 and 28 million/mL, and motility 0%. The next step is:
a.vital stain.
b.immunobead assay.
c.repeat semen analysis.
d.sperm chromatin structure assay (SCSA).
e.computer-assisted semen analysis (CASA).
.Semen observed under phase contrast light microscopy reveals abundant round cells similar in size and shape to leukocytes. The next step is:
a.semen culture.
b.Papanicolaou staining.
c.transrectal ultrasound.
d.ciprofloxacin, 1 g daily for 4 weeks.
e.ibuprofen, 400 mg daily for 2 weeks.
.A direct assay of sperm-head DNA fragmentation is the:
a.terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay.
b.acid comet assay.
c.alkaline comet assay.
d.sperm chromatin dispersion (SCD) assay.
e.SCSA.
.The assay that most closely models incubational in vitro fertilization is:
a.reactive oxygen species-total antioxidant capacity (ROS-TAc).
b.Penetrak assay.
c.Tru-trax assay.
d.sperm penetration assay.
e.acrosomal assay.
.A 26-year-old man presenting for fertility evaluation has two semen analyses, one with volume 2.1 mL and density 32 million/mL, and another with volume
2.3mL and density 28 million/mL. No motile sperm are observed in either, and vital stain demonstrated greater than 80% metabolically active sperm in both. The next step is:
a.immunobead assay.
b.pyospermia stain.
c.electron microscopy.
d.SCSA.
e.repeat semen analysis.
.A 30-year-old man has azoospermia. Physical examination reveals absent vasa bilaterally. CFTR analysis reveals a ΔF508 mutation. The next step is:
a.repeat CFTR analysis of the man with a 1600-mutation screen.
b.repeat semen analysis.
c.CFTR analysis of his wife.
d.testicular sperm extraction.
e.testis biopsy.
.A 28-year-old man desires a biological child. Physical examination is normal. Two semen analyses reveals azoospermia with volumes of 0.8 and 0.7 mL, and no sperm is identified in a postejaculatory urinalysis. FSH is 3.2 IU/L. Transrectal ultrasound reveals seminal vesicles of 0.9 and 1.1 cm in largest diameter, and no midline cyst is visualized. The next step is:
a.reassurance.
b.testis biopsy.
c.repeat semen analysis.
d.transurethral resection of ejaculatory ducts.
e.testis sperm extraction and cryopreservation.
.A 33-year-old man desires a biological child and is found to have azoospermia with semen volumes 2.2 and 2.4 mL on two analyses. Longitudinal axis of the left testis is 3.3 cm, and the right is 3.5 cm. Serum FSH is 9.3 IU/L, and testosterone is 440 ng/dL. The next step is:
a.testis biopsy.
b.epididymovasostomy.
c.repeat semen analysis.
d.microsurgical testis sperm extraction.
e.clomiphene citrate, 50 mg every other day.
.A 30-year-old man desires a biological child with his 28-year-old wife. Her evaluation is normal. Semen analysis reveals density 84 million/mL and globozoospermia. The next step is:
a.repeat semen analysis.
b.clomiphene citrate, 50 mg every other day.
c.in vitro fertilization after incubation of sperm with pentoxifylline.
d.intracytoplasmic sperm injection with ejaculated sperm.
e.microsurgical testis sperm extraction.
.The most common genetic cause of male infertility is:
a.r(Y).
b.45,X0.
c.47,XXY.
d.47,XYY.
e.46,XY/47,XXY.
.The biological system responsible for protecting haploid male germ cells from the immune system is:
a.IgG.
b.PSA.
c.natural killer cells.
d.reactive oxygen species.
e.Sertoli cell tight junctions.
.A man presents with azoospermia. Testis longitudinal axis is 3.0 cm bilaterally, and the testes are soft. Laboratory evaluation reveals testosterone 140 ng/dL, LH less than 1.0 IU/L, and FSH less than 1.0 IU/L. The next step is:
a.repeat semen analysis.
b.transrectal ultrasound.
c.microsurgical testis sperm extraction.
d.smell test.
e.Y-chromosomal microdeletion assay.
.A man presents with erectile dysfunction and azoospermia. Testis longitudinal axis is 5 cm bilaterally, and the testes are firm. Laboratory evaluation reveals bioavailable testosterone 150 ng/dL and prolactin 42 μg/L. The next step is:
a.repeat prolactin.
b.bromocriptine, 2.5 mg orally per day.
c.cabergoline, 0.25 mg orally twice a week.
d.clomiphene citrate, 50 mg orally every other day.
e.cranial magnetic resonance imaging.
.Laboratory values associated with androgen receptor insensitivity include:
a.significantly elevated testosterone, LH, and FSH.
b.mildly elevated testosterone, LH, and FSH.
c.significantly elevated testosterone, mildly elevated LH, and normal FSH.
d.decreased testosterone, and elevated LH and FSH.
e.decreased testosterone, LH, and FSH.
.The most common mutation in the cystic fibrosis transmembrane conductance region, or CFTR, is:
a.R117H.
b.R334W.
c.R347P.
d.ΔF508.
e.G542X.
.A man presents with a palpable right-sided varicocele of 3 months onset and no varicocele palpable on the left side. Testis longitudinal axis is 5 cm bilaterally, and a semen analysis reveals volume 2.0 mL, density 33